Maternal Child Health Survey

The Tompkins County Health Department is conducting a survey about local Maternal Child Health services, including the Medicaid Obstetric and Maternal Services (MOMS) program. The purpose of the survey is to find out what you think about the services that are currently available, and what is needed, so we can better serve the Tompkins County community.

The survey is completely anonymous, and the information we collect will not be used for any other purpose. It should only take you a few minutes. Thank you.

Question Title

* 1. Which scenario best describes you?

Parent

Expecting

Thinking about having children

Other (please specify)

None of the above

Question Title

* 2. How would you evaluate the following services for providing maternal and child health care?

	Poor	Fair	Good	Very Good	Excellent	Have not used this service
Tompkins County Health Department	Tompkins County Health Department Poor	Tompkins County Health Department Fair	Tompkins County Health Department Good	Tompkins County Health Department Very Good	Tompkins County Health Department Excellent	Tompkins County Health Department Have not used this service
OBGYN	OBGYN Poor	OBGYN Fair	OBGYN Good	OBGYN Very Good	OBGYN Excellent	OBGYN Have not used this service
Planned Parenthood	Planned Parenthood Poor	Planned Parenthood Fair	Planned Parenthood Good	Planned Parenthood Very Good	Planned Parenthood Excellent	Planned Parenthood Have not used this service
WIC	WIC Poor	WIC Fair	WIC Good	WIC Very Good	WIC Excellent	WIC Have not used this service
MOMS	MOMS Poor	MOMS Fair	MOMS Good	MOMS Very Good	MOMS Excellent	MOMS Have not used this service
Pediatric Offices	Pediatric Offices Poor	Pediatric Offices Fair	Pediatric Offices Good	Pediatric Offices Very Good	Pediatric Offices Excellent	Pediatric Offices Have not used this service

Other (please specify)

Question Title

* 3. What barriers to Maternal and Child Health services are you now experiencing, or have you experienced in the past? (Check all that apply.)

Transportation

Stigma

Negative experience with providers

Cost of services or lack of adequate health insurance

No guidance on where to find these services

Don't know about these services

Have not used these services

Other (please specify)

None of the above

Question Title

* 4. Have you ever participated in the MOMS program?

Yes